THE BUG PARADOX

01-September-2018

RAJGOPAL NIDAMBOOR

The use of antibiotics is based on the paradigm there is a battle in progress in the body and it must be resolved — and, that the body is not capable of success without drug support. Antibiotics ‘kill’ microorganisms related to a given illness or disease, all right; they also impede their duplication. The downside is disease-causing bacteria have the innate ability to resist drugs, or antibiotics, just like our bodies defy bacteria. This is one reason why your physician increases the dosage of your medicine even when the ‘cause’ or ‘character’ of infection is the same as before. Besides, antibiotics do not produce immune-stimulating effects; they lead to ‘drug-dependence,’ or cause side-effects — some of them serious — including dysbiosis, or microbial imbalance in the body.

The recent ‘breaking news’ of Canadian scientists emerging with and holding a simple fungus found in a dirt sample as the key to killing some of the newest strains of antibiotic-resistant bacteria, known as ‘superbugs,’ comes like a breath of fresh air. The study, published in Nature, describes a natural fungal product capable of disarming the bacteria’s genetic defences and allowing once powerless antibiotics to work again. Yet another new study conducted in India reports that scientists in Bengaluru have developed a novel way of attacking drug-resistant bacteria. The new molecule targets the bacterial cell membrane directly — more interestingly, the study concurs, that the patient would not require multiple dosages of the same drug.

This is certainly roseate apotheosis — a small, big step, but a fabulous leap, in the right direction. Yet, the fact of the matter is microorganisms, or bacteria, are smart operators. They are adept at beating our radar each time we come up with something new, even if it is something spectacular, or never-used-before, new-fangled idea.

It goes without saying that new, stunningly virulent, and resurgent illnesses, or diseases, have been escalating around the globe, with alarming intensity, and advancing more rapidly than ever before. This epidemic of epidemics not only signals a crisis in human history, but also the tizzy dance of mutual adaptation that we ‘share’ with our microbial fellow travellers. We have got only to blame ourselves for such a horrid reality and also complexity. We have brought the ‘wolf’ through the door by rendering, and disturbing, the natural fabric of our environment, changing our behaviours and, paradoxically, by our inventiveness to increasing the length and quality of our lives.

So, how — and, most importantly, why — have we gone wrong?

To cull Arno Karlen, PhD, a psychoanalyst, researcher, and author, “For each new disease known to the general public, there are a dozen others; because, the wheels of biological change keep turning faster. The shared evolution of humans and microbes has accelerated to a frenzied pace. For example, much has been written about AIDS, but far less about other new diseases. Our scientific and historical research is fragmented, like pieces of mosaic rarely assembled in more bits and patches. We have been slow to understand that we live in a new biocultural era. For decades, we cherished the myth that infectious diseases were fading forever. This was a posture born of inherited optimism.”

His words speak of an inescapable truth: about new emerging viruses and the increase of microbial resistance to drugs. You get the point. Without seeing our larger evolutionary picture, we cannot respond intelligently to challenges facing our health and survival. To pick one example — for 10,000 years, since the first hunter gatherers settled in villages, infections had killed more people than war and famine. New diseases, as is obvious, do not fall from the sky or leap from some mysterious black box. “Parasitism and disease are a natural, in fact necessary, part of life. They are fundamental to the existence of everything — from the earliest, simplest organisms to human beings.”

That man provides new ecological slots for microbes has been an old thread with a new twist: a belief, as old as the hills. We have, according to Karlen, brought new epidemics by our travel and technology, our diet, clothing, and sex lives. We are now living through a scourge of new epidemics. And, in so doing, we have augmented a dramatic panorama of the natural history of disease. This also highlights a savage test: where do new diseases come from, why have old spectres such as tuberculosis [TB] and cholera returned with a vengeance, and why now? This is not all. Think of the terrifying impact of measles and smallpox that raked the ancient empires of Rome and China, not to speak of intertwined stories of leprosy and the onslaught of European microbes that devastated the natives of America, including the much-forgotten influenza pandemic that killed tens of thousands in the early part of the last century — or, the diabolical emergence of new illnesses, with funny names, such as the ‘old-new’ dengue, chikungunya, bird flu, or SARS, among others.

It is imperative, albeit fundamental, to understand the complex and vital relationship between man and microbes, in the wake of new problems posed and challenges thrown by modern diseases, such as AIDS, Lyme disease, and the deadly Ebola virus. In Karlen’s words, “Every age of new plenty demanded a price of biological readaptation. Diseases occurred in increased numbers when our ancestors left the trees for the ground; when nomads became hunters and spread around the world; when village life began, and with the growth of cities; with the start of global travel, and then with the Industrial Revolution; and, with the social and technological results of prosperity.”

When we dig into the nuggets of history, it provides us a depressing case in point of the trials and tribulations of Neolithic life: the Mayan culture, for instance. The Mayan empire, which covered more than 200,000 square km in Guatemala and Mexico, lasted 1,500 years, what with its splendid stone cities. Yet, a thousand years ago, the empire collapsed; the jungle reclaimed its ruins, and people reverted to village life. Studies of Mayan bones and of the Mayans’ living descendants show that they were primed for disaster by their ‘use’ of the environment and by their parasites.” An objective lesson for everyone to learn from — both in terms of history and reality.

It is apparent that for a thousand years before their empire fell, the Mayans’ dependence on maize and beans reduced their size and robustness. The skulls of ancient Mayan children show pitting of the orbital bones and spongy degeneration of the cranium — classic signs of acute iron-deficiency anaemia. Anaemia can have a number of causes, including lack of iron intake, loss of iron in sweat or blood, or anything that impedes iron absorption, iron metabolism, or haemoglobin formation. The soil the Mayans farmed was poor in iron. As a result, so were their crops, and mother’s milk. Their diet was low in vitamin C too, which the body needs to absorb and use iron. It lacked proteins, no less, needed for haemoglobin synthesis.

“The custom of soaking maize in water,” as Karlen observed, “destroyed most of the folic acid and vitamin B12 [cobalamin] needed for developing red blood cells. Maize contains iron, but it also has phytic acid, which inhibits iron absorption in the intestine. The Mayan practice of stone-grinding maize altered it chemically, so iron absorption was further inhibited. Heavy sweating, unavoidable in the Mesoamerican tropics, caused more iron loss, as did intestinal bleeding caused by hookworm, tapeworm, and other parasites common in Mayan farmers. In addition, the Mayan diet lacked zinc and other substances needed for growth and resistance to infections.”

Forget about bird flu, research today suggests that plague may be a disaster waiting to happen again — and, we are but anything prepared to combat it, notwithstanding our advance. Just think of the sordid images caused by diseases like cholera, bubonic plague, haemorrhagic fever, leprosy, and other viruses, in mediaeval British and post-Independent India. We cannot, at our own peril, ignore new food-borne diseases that are appearing every other day, some of them lethal. The inference is obvious — the twenty-first century will be a savage test. This is because, “infectious diseases remain the world’s leading cause of death; they will remain so for a long time to come. Our most troubling vulnerability is our spotted record of serving our own best interests. What is not adequately understood is that in our time, because of mobility and high-speed travel and trade, no disease is irrelevant to the rest of the world.”

The scenario, on the whole, is gloomy; difficult, but not impossible. There is hope, notwithstanding the on-going abuse of our ecosystem and the dramatic changes in the biosphere. The paradox is also stunning. Our primate forebears had to cope with new diseases, and so did our Stone Age forebears. So did the first farmers and the first city dwellers. Notwithstanding struggles and crises, they were able to survive the challenges. Presumably we will, with our spectacular diagnostic and healing armamentarium, our resilient immune system and imagination, including our marvellous ability to adapt and flourish.

Yet, it goes without saying that we are caught in a flagrant web — the recurring era of crises, where we are accelerating the escalation and expansion of new pathogens. They, like us, are trying to adapt and survive. The best thing to do is — we must, no matter what, conquer some of the diseases and make a judicious armistice with some we can’t defeat, notwithstanding our high-tech medicinal and therapeutic ‘ammo.’